Health Wonk Review: Open season on open enrollment edition

November 5, 2015

You’ll feel better after reading this

Health Wonks are nothing if not opinionated. Their views burn bright in the submissions I received for this edition, which coincides with the start of the Affordable Care Act’s third annual open enrollment period. Enjoy!

Skyfall?

GOP presidential candidates including Marco Rubio keep insisting that Medicare is on a path to bankruptcy. But as Medicare Resources explains, the insolvency date has been pushed back 13 years under Obama’s watch. On the other hand, the GOP has actually worsened Medicare’s finances through implementation of Part C (Medicare Advantage) and Part D (drug benefit).

Health Affairs Blog chronicles two warring political narratives about health spending growth. Conservatives blame the patient, while Progressives blame physicians. Author Jeff Goldsmith dissects the narratives, finds fault with both, and suggests a more complex and balanced approach. Now there’s a wonkish mindset for you!

Mattering mabobs of managerialism

Leave it to Health Care Renewal to scour the globe for medical managerial malfeasance. In The Scourge of Managerialism we learn of an Australian source that sums up the sins of mission-hostile management and its adverse impact on patients and academics.

Psych out

Workers’ comp claims adjusters want nothing to do with psychologists, fearing they’ll turn any referral into a lifetime annuity. Workers’ Comp Insider has the scoop, as expected.

Where B all the hospitalists?

There’s no specific billing code or board certification for hospitalists, so how do you track them down? The Hospital Leader has two suggestions: ask everyone “are you a hospitalist?” or dig deep into the Medicare Part B claims database to identify hospitalists based on what they bill. The analysis lays the groundwork for important conversations about care delivery, but also makes it clear that hospitalists need a unique billing code.

Bundle it up

Archway Health Advisors describes a real-time patient tracking app to improve patient care during a bundled payment episode. This timely feedback is a must if providers are to manage care episodes across the continuum.

Where and what are MACRA and MIPS?

With the notable exception of health wonks — and I do mean notable– no one paid much attention to the provisions of the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) beyond the so-called ‘permanent doc fix.’ But fortunately Healthcare Economist lays it out for everyone else, explaining how MIPS and Alternative Payment Models will make significant impacts on physician payment.

Open season on open enrollment

The National Center for Policy Analysis has seen Obamacare Open Enrollment before, and is none too thrilled to see it come around again. The Nothing to Celebrate post makes important points about rising premiums, especially for those who don’t qualify for subsidies. We’ve seen premiums jump with our own business in Massachusetts. Still, it probably would have been worth noting that premiums for those with subsidies aren’t really changing.

ACASignups has been looking at the data to try to figure out which way ACA exchange enrollments are heading. From this –perhaps the wonkiest post of the whole bunch– it appears that while overall exchange enrollment is up, the big plans are losing market share. From where I sit that’s no bad thing. As premiums rise (see post above) patients who are willing to switch plans are often able to keep their own premiums well below the advertised levels of increase, typically by choosing plans from smaller, more nimble carriers.

InsureBlog has been around for more than a decade, and I’m still waiting for the first pro-Obama post. (Actually I never really got my hopes up.) In any case Musings on ACA Open Enrollment Day tells the story of a patient skipping care because of a super-high deductible.

Finally, Managed Care Matters comes to tell us that the whole idea of high deductible plans is “stupid.” They just lead to cost shifting and don’t encourage lower spending by high-cost members.

That’s it folks! Meanwhile if you’re in the mood for more, you can always check the Health Wonk Review site for past posts and upcoming hosts.

4 thoughts on “Health Wonk Review: Open season on open enrollment edition”

Hi David, You are correct that many people (perhaps 75%) will experience only minimal increases in their exchange plan premiums, because premiums are capped as a percent of income. However, the average taxpayer subsidy will increase substantially. For the sake of argument, let’s assume the average cost rises by, say, 15%. On a health plan costing $3,500 per year, that’s an increase of about $525. Maybe $500 of that would be covered by a higher subsidy. That’s worrisome because increased subsidies will increase the deficit, and will continue to do so year after year.